What Trump's Executive Order Means for the Syrian Health Crisis

The U.S. took in 12,486 Syrian refugees in 2016, a tiny fraction of the 11 million Syrians who have fled their homes since the war there started in 2011. Now, with the signing of President Trump’s executive order, that number will be brought to zero—indefinitely.

This means the U.S. is effectively shutting out a group of people who are suffering from one of the worst humanitarian and public-health crises in recent memory. Syrians are living in medieval conditions, contracting diseases that had been long ago eliminated by vaccination, such as polio. Even highly treatable conditions like diabetes go unchecked, since the Syrian government and its allies have systematically targeted and killed nearly 700 Syrian doctors, according to Physicians for Human Rights.

The five million Syrians who have managed to flee are mostly stuck in refugee camps in neighboring poor countries, such as Jordan and Lebanon, where medical care is also sparse.

As Doctors Without Borders put it in a statement Saturday, “The president’s executive order will effectively keep people trapped in war zones, directly endangering their lives.”

For a closer look at the crisis and how Trump’s order will affect it, I spoke with Jason Cone, executive director of Doctors Without Borders—U.S. The organization has set up clinics in refugee camps and, despite the threat of bombings and kidnappings, clandestine hospitals within Syria itself. An edited transcript of our conversation follows.

Olga Khazan: What is the situation like for both internally and externally displaced Syrians, as far as their ability to get medical services?

Jason Cone: We have five million Syrian refugees in the region. A roughly equivalent number are internally displaced in the country. For those still stuck in the country, their entire health system has been devastated. For the six years of the war, the health system has been targeted, doctors have been killed and tortured, hospitals have been bombed systematically throughout the war. There are few remaining doctors, there are hardly any left. Access to healthcare generally has been devastated.

If you look at Syrians who had to flee the country, a place like Lebanon, one in four people in Lebanon are now a Syrian refugee. The health system cannot cope with that. That’s why my organization and others have had to open up medical programs in different parts of the country. Whether it’s for women to have a safe delivery, or whether it’s for someone who needs to restart diabetes treatment. We also have hospitals in Jordan, where one in 10 people are Syrian refugees. We opened up a chronic-disease clinic because a lot of patients we’re seeing are suffering from complications from not managing their chronic diseases properly. They lost access to their normal prescriptions when they had to flee the country.

All of this puts tremendous strain on the health systems of the countries that have hosted people. And then there are war-related injuries, which many people need extensive reconstructive surgeries if they survive. We have a trauma center in Jordan and a reconstructive surgery center in Amman, and those programs are running at mass capacity. It’s really a drop in the ocean as far as the need for people who have blast injuries, damage to their face, burn injuries. We run a hospital in Idlib, inside Syria, it’s an emergency hospital. It has 150 emergency cases a week, and 50 percent of those are burn injuries. Those people need skin grafts, they need rehab if their hands are burned.

Khazan: What happens if I have diabetes and I’m in Syria right now?

Cone: It’s incredibly limited access. Even if you’ve gotten out, it’s going to be a challenge. And managing diabetes, that’s also a lot about your lifestyle in terms of diet. If you’re in a refugee, you don’t have access to the kind of varied and healthy diet to manage something like that.

Khazan: It seems to me like the U.S. was already not taking in very many Syrian refugees, even before this executive order.

Cone: Canada has taken in far more Syrian refugees than the United States. It’s taking people one to two years to make it through the [U.S.] screening process. That speaks to the dubious nature of the executive order—the system is quite robust and already very rigorous in terms of people screening before they make it through and get to be resettled.

It’s not really the same as what happened with Cuba and the end of the Vietnam war, [as far as the U.S. taking in lots of refugees]. The acceptance of people is not commensurate with the scale of the crisis. What is the right number? It’s hard to say. It certainly it wasn’t enough before, and it’s definitely not now.

The vast majority of refugees worldwide are hosted by neighboring countries, and those are some of the poorer countries in the world. They are really bearing the responsibility of the global crisis of forced displacement. The idea that richer countries or Western nations are the ones that are taking care of everyone, that’s just not the case at all.

Khazan: One draft of the executive order included the idea of “safe zones” within Syria, though that was later excluded. Would something like that work? If not, why not?

Cone: We’re talking about a conflict that involves dozens of armed groups, not even counting Russia, Turkey, Hezbollah, Iran, various Kurdish groups. Just the practicalities of doing something like that are daunting. And even if you were able to create a safe zone, you have to create the conditions to allow a sufficient amount of humanitarian aid to come, and there aren’t very many good precedents for that in this war. So why they would be feasible now remains to be seen. And also, frankly, people should be allowed to flee and seek sanctuary. They shouldn’t be forced to stay inside Syria. The health system is devastated, there’s very little aid, the infrastructure has been destroyed. People need to have some possibility of choice.

Khazan: What types of treatable diseases are Syrians currently dying of?

Cone: With [the flesh-eating parasite] leishmaniasis, that has to do with the living conditions, without proper shelter, without access to clean water and soap. [Cases of leishmaniasis in Syria rose from 3,000 before the war to more than 100,000 in 2014.] Polio is something, the vaccination system and public health system has collapsed. You’re going to see children born who haven’t been vaccinated against polio, measles, tetanus. Once your health system collapses, diseases can come back because you lose herd immunity. And polio, as we’ve seen in Pakistan and Nigeria, when the vaccine campaigns aren’t happening, it’s a very resilient disease that can come back very quickly. War-related issues, like trauma, dominate. Doctors have to focus on the trauma and triage, and inevitably what happens is the health system is not capable of dealing with chronic conditions. You have to make choices with limited resources.

Khazan: What about Syrian refugees in Turkey, Lebanon, and Jordan? What are their medical needs?

Cone: We run a clinic, a maternal and child health clinic, in Shatila refugee camp in Beirut, that predominantly serves a refugee population. We’ll be opening another hospital in the Bekaa Valley that’s focused on pediatric care and some reconstructive surgery as well. There’s nothing that tells us the conflict is going to end soon, and we’ll need to continue to support these health systems.

Khazan: What are the obstacles, for MSF, to opening up more medical facilities inside Syria?

Cone: We had five staff members kidnapped in January 2014 by the Islamic State. That’s prevented us from being able to negotiate access to any of the areas controlled by the Islamic State. We’ve tried to get access to areas controlled by the government, they have not accepted us. We’re basically running with national staff who have worked with us for many years. The normal way of us working, of having international teams, there’s no way to do that, because there’s no acceptance or trust of internationals. We’ve had to run clinics underground and bring in medical supplies and support a network of clinics. We’ve had to operate in a completely different model than we traditionally do in terms of negotiating our access.

Khazan: What do you foresee being the long-term impacts on this generation of Syrians of not being able to get medical care?

Cone: The one area — besides the immediate injuries that children might have received, like gunshot wounds, that they haven’t been able to get the right care for—is the mental trauma from the conflict. You’re talking about millions of people who have experienced extreme mental trauma, and if we talk about not having sufficient health systems to care for their physical medical needs, there’s nowhere near the assistance that they’ll need to cope with trauma that’s inter-generational. That’s an experience that will be passed on for a long time.